Legislature(2017 - 2018)BUTROVICH 205

03/12/2018 01:30 PM HEALTH & SOCIAL SERVICES

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Audio Topic
01:30:12 PM Start
01:30:38 PM SB193
02:21:10 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: Randall Burns, Director, DHSS TELECONFERENCED
Division of Behavioral Health
"Behavioral Health Continuum of Care and the
Alaska Psychiatric Institution"
-- Testimony <Invitation Only> --
<Above Item Removed from Agenda>
*+ SB 193 MED. ASSISTANCE WORK REQUIREMENT TELECONFERENCED
Heard & Held
-- Testimony <Invited and Public> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      SENATE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                    
                         March 12, 2018                                                                                         
                           1:30 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator David Wilson, Chair                                                                                                     
Senator Natasha von Imhof, Vice Chair                                                                                           
Senator Cathy Giessel                                                                                                           
Senator Peter Micciche                                                                                                          
Senator Tom Begich                                                                                                              
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
SENATE BILL NO. 193                                                                                                             
"An Act  requiring the Department  of Health and  Social Services                                                               
to apply for a waiver  to establish work requirements for certain                                                               
adults  who  are  eligible  for   the  state  medical  assistance                                                               
program."                                                                                                                       
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: SB 193                                                                                                                  
SHORT TITLE: MED. ASSISTANCE WORK REQUIREMENT                                                                                   
SPONSOR(s): SENATOR(s) KELLY                                                                                                    
                                                                                                                                
02/19/18       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/19/18       (S)       HSS, FIN                                                                                               
03/12/18       (S)       HSS AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
SENATOR PETE KELLY                                                                                                              
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Sponsor of SB 193.                                                                                        
                                                                                                                                
HEATHER CARPENTER, Staff                                                                                                        
Senator Pete Kelly                                                                                                              
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Presented the sectional for SB 193.                                                                       
                                                                                                                                
JON SHERWOOD, Deputy Commissioner                                                                                               
Medicaid & Health Care Policy                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions on SB 193.                                                                             
                                                                                                                                
MONICA WINDOM, Director                                                                                                         
Division of Public Assistance                                                                                                   
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT: Answered questions on SB 193.                                                                             
                                                                                                                                
MIKE COONS, President                                                                                                           
Alaska Chapter of Mature American Citizens (AMAC)                                                                               
Palmer, Alaska                                                                                                                  
POSITION STATEMENT: Supported SB 193.                                                                                         
                                                                                                                                
JESSICA CLER, Alaska Public Affairs Manager                                                                                     
Planned Parenthood Votes Northwest and Hawaii                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Opposed SB 193.                                                                                           
                                                                                                                                
JEREMY PRICE, Alaska State Director                                                                                             
Americans for Prosperity                                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT: Supported SB 193.                                                                                         
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
1:30:12 PM                                                                                                                    
CHAIR DAVID WILSON  called the Senate Health  and Social Services                                                             
Standing Committee meeting  to order at 1:30 p.m.  Present at the                                                               
call  to order  were  Senators Giessel,  von  Imhof, Begich,  and                                                               
Chair  Wilson. Senator  Micciche  joined  shortly thereafter.  He                                                               
advised that  the presentation  regarding the  "Behavioral Health                                                               
Continuum  of Care  and the  Alaska Psychiatric  Institution" had                                                               
been removed from the agenda.                                                                                                   
                                                                                                                                
            SB 193-MED. ASSISTANCE WORK REQUIREMENT                                                                         
                                                                                                                                
1:30:38 PM                                                                                                                    
CHAIR WILSON announced the consideration of SB 193.                                                                             
                                                                                                                                
1:31:16 PM                                                                                                                    
SENATOR PETE KELLY,  Alaska State Legislature, sponsor  of SB 193                                                               
said  the  bill answers  the  question  of whether  Alaskans  who                                                               
receive Medicaid  should be  required to work  or volunteer  as a                                                               
condition of their benefits. He said  I believe the answer is yes                                                               
and SB 193 is a simple and  direct path to achieving that end. He                                                               
clarified that SB 193 does  not require the elderly, disabled, or                                                               
new mothers  to work. The exemptions  are spelled out on  page 2,                                                               
lines  6-19.  People  who  are  not  employed,  volunteering,  or                                                               
otherwise  exempt  can  receive  exemptions if  they  are  in  an                                                               
education  or  training  program  that will  lead  to  work.  The                                                               
genesis  for the  bill was  an announcement  by CMS  [Centers for                                                               
Medicare & Medicaid Services]  allowing work requirements through                                                               
the structure of the Medicaid  Section 1115 waivers. He explained                                                               
that SB  193 applies to  a narrow  band of Medicaid  users, those                                                               
who can work but  do not. It's not so much  about saving money as                                                               
encouraging  people  to  get  out  and  build  their  skills  and                                                               
reputation  and work  their way  out of  the welfare  or Medicaid                                                               
system. He described the bill  as philosophical in that it should                                                               
be  the default  position of  Americans that  those who  can work                                                               
should work.  He opined  that depending  on government  funds has                                                               
frozen people  in place and denied  them the dignity of  work and                                                               
joining their fellow Alaskans who have  a reason to get up in the                                                               
morning and make this state a better place.                                                                                     
                                                                                                                                
1:35:55 PM                                                                                                                    
HEATHER  CARPENTER,  Staff,  Senator  Pete  Kelly,  Alaska  State                                                               
Legislature, paraphrased the following  sectional analysis for SB
193:                                                                                                                            
                                                                                                                                
    Section 1:                                                                                                                
    Amends AS 47.07.036  to direct the DHSS  to apply for  a                                                                    
    section 1  115  waiver of  the  Social Security  Act  to                                                                    
    establish a work requirement for adults in  the Medicaid                                                                    
    program who not meet the criteria to be exempted.                                                                           
                                                                                                                                
    The waiver must include the following:                                                                                      
         (l) Requires an able-bodied Medicaid recipient to                                                                      
           participate in  work activities for  a minimum of                                                                    
           20 hours  each week. Actively seeking employment,                                                                    
           participating   in  an   education   or  training                                                                    
           program, volunteering, or engaging in subsistence                                                                    
           activities also  are counted  towards the 20-hour                                                                    
           requirement.                                                                                                         
        (2) If a Medicaid recipient is also receiving                                                                           
           benefits under Alaska Temporary Assistance                                                                           
           Program   and   in  compliance   with   the  work                                                                    
           requirements listed under AS 47.27.035, then they                                                                    
           automatically  meet   the  work  requirement  for                                                                    
           Medicaid.                                                                                                            
        (3) Exempt Medicaid recipients who are:                                                                                 
             a. Children or elderly (Under 18 years old and                                                                     
                over 65 years old)                                                                                              
             b. The parent or caretaker of a dependent child                                                                    
                of up to 12  months of age and the parent or                                                                    
                caretaker  is providing  home  care  for the                                                                    
                child                                                                                                           
             c. The parent or caretaker of a child                                                                              
                experiencing a disability  and the parent or                                                                    
                caretaker  is providing  home  care  for the                                                                    
                children                                                                                                        
             d. The caretaker of a relative who is                                                                              
                experiencing a  disability and  requires 24-                                                                    
                hour care                                                                                                       
             e. The parent or caretaker of a child under six                                                                    
                years  of age  and  the parent  or caretaker                                                                    
                demonstrated that  appropriate child care is                                                                    
                not available                                                                                                   
             f. Unable to work for medical reasons, as                                                                          
                determined    by    a    licensed    medical                                                                    
                professional                                                                                                    
        (4) Ensure that the work requirement does not impact                                                                    
           a Medicaid recipient from obtaining substance                                                                        
           abuse treatment                                                                                                      
        (5) A notification to all Medicaid receipts once the                                                                    
           waiver is approved, and a 90 day notice of non-                                                                      
           compliance with the work requirement before                                                                          
           benefits are terminated.                                                                                             
                                                                                                                                
MS.  CARPENTER  noted  that  pregnant  women  would  need  to  be                                                               
specifically  added to  the list  in paragraph  (3). The  sponsor                                                               
thought  that  referencing  the Temporary  Assistance  for  Needy                                                               
Families  (TANF)   statutes  was   sufficient,  but   the  deputy                                                               
commissioner  pointed out  that  not all  pregnant women  receive                                                               
TANF.                                                                                                                           
                                                                                                                                
1:39:58 PM                                                                                                                    
SENATOR GIESSEL asked why the sponsor chose to do this through                                                                  
the Section 1115 Medicaid waiver.                                                                                               
                                                                                                                                
SENATOR  KELLY said  the CMS  guidance letter  directed doing  it                                                               
through that process.                                                                                                           
                                                                                                                                
SENATOR  GIESSEL,  noting  that   at  least  one  state  received                                                               
approval, asked  how that  could happened  so quickly  through an                                                               
1115 waiver process.                                                                                                            
                                                                                                                                
MS. CARPENTER said she did not  know, but the CMS guidance letter                                                               
said that  applying through the  waiver was the only  avenue. She                                                               
added that the bill tests  the theory that work requirements will                                                               
improve health outcomes of people on the Medicaid program.                                                                      
                                                                                                                                
SENATOR  KELLY said  it  is  an interesting  point  that the  CMS                                                               
requirement has nothing  to do with the dignity of  work, but the                                                               
idea that people who work will be healthier.                                                                                    
                                                                                                                                
SENATOR GIESSEL shared  that her concern about  using the Section                                                               
1115 Medicaid  waiver was  that it is  a very  ponderous process.                                                               
For example,  the regulations  for the  2015 Medicaid  reform for                                                               
behavioral health  were finally  filed in  January 2018  and will                                                               
take two more years to implement.                                                                                               
                                                                                                                                
1:42:30 PM                                                                                                                    
SENATOR BEGICH  said the  provision on page  2, line  20, "ensure                                                               
that the  work requirement  does not prevent  a recipient  with a                                                               
substance  abuse disorder  from  obtaining appropriate  treatment                                                               
for  the  substance abuse  disorder,"  was  insightful. He  asked                                                               
whether  there was  a standard  to determine  whether someone  is                                                               
able-bodied.                                                                                                                    
                                                                                                                                
MS. CARPENTER said the department is  used to these terms and CMS                                                               
puts  out guidance  on  them. Someone  able-bodied  would not  be                                                               
enrolled  in  Medicaid  through disability.  They  might  have  a                                                               
disability,  but it  will not  be  the Social  Security level  of                                                               
disability.                                                                                                                     
                                                                                                                                
SENATOR  BEGICH  said  he  likes   that  the  bill  mirrors  TANF                                                               
requirements.  He asked  whether  the sponsor  would consider  an                                                               
amendment  to  allow a  caseworker  to  suggest a  modified  work                                                               
requirement of less than 20 hours a week.                                                                                       
                                                                                                                                
SENATOR KELLY said  he assumes it would be  appropriate under the                                                               
waiver.  He  would  not  object  to  giving  the  department  the                                                               
flexibility it  needs. He  added that  volunteering is  always an                                                               
option when work is difficult to find.                                                                                          
                                                                                                                                
MS.  CARPENTER said  the CMS  letter  lays out  guidance for  the                                                               
department on  how to work  with people  who will be  affected by                                                               
this  requirement.  The  guidance addresses  the  Americans  with                                                               
Disabilities Act and  Section 504 of the  Rehabilitation Act. The                                                               
letter  says,   "States  should  include,  in   their  proposals,                                                               
information  regarding  their  plans for  compliance  with  these                                                               
requirements, including provision  of reasonable modifications in                                                               
work or community engagement requirements."                                                                                     
                                                                                                                                
1:46:20 PM                                                                                                                    
SENATOR BEGICH said  the bill might require a  minor amendment to                                                               
add that option.                                                                                                                
                                                                                                                                
MS.  CARPENTER  said  she  wanted to  hear  from  the  department                                                               
because the allowance for medical exemptions might address that.                                                                
                                                                                                                                
SENATOR BEGICH  asked how many  people the bill would  affect and                                                               
how many might be removed.                                                                                                      
                                                                                                                                
SENATOR KELLY said  he has heard that as many  as 25,000 might be                                                               
affected,  but  that seems  high  since  many  of the  people  on                                                               
Medicaid under the expansion do work.                                                                                           
                                                                                                                                
CHAIR WILSON said the DHSS fiscal note provides answer.                                                                         
                                                                                                                                
SENATOR MICCICHE  said he  is a cosponsor  who believes  the bill                                                               
has peripheral  values that  are more  significant than  the bill                                                               
itself. Social  programs have changed  from something  to relieve                                                               
dire  need  to  something  of   convenience.  The  20  hours  are                                                               
extremely important  because it  shows people  they have  so much                                                               
more potential  to excel.  People are  afraid to  succeed because                                                               
they fear losing their benefits. He  is sure they will hear about                                                               
how  many  people  now  are working.  The  definitions  used  for                                                               
working  are  generous.  The  expansion   population  has  to  be                                                               
working, so he's not sure it  includes them at all. He would like                                                               
to  see a  table  of all  the costs,  which  are interesting  and                                                               
somewhat creative.                                                                                                              
                                                                                                                                
CHAIR WILSON said  he also was going to ask  the department for a                                                               
memo to summarize  all the expenditures and fiscal  notes and how                                                               
they interact.                                                                                                                  
                                                                                                                                
SENATOR  KELLY said  the department  representatives in  the room                                                               
are professional  and hard-working  people, but the  large fiscal                                                               
note reflects  a philosophical  difference. The  discussion about                                                               
the fiscal note is yet to come.                                                                                                 
                                                                                                                                
1:50:32 PM                                                                                                                    
SENATOR  MICCICHE reiterated  support for  the bill  and deferred                                                               
discussion  about  the  appropriateness  of the  fiscal  note  to                                                               
Finance.                                                                                                                        
                                                                                                                                
SENATOR  VON IMHOF  said the  fiscal notes  will be  discussed in                                                               
Finance, but  it is the  crux of the  bill. She pointed  out that                                                               
Kentucky  cited administrative  burdens  as one  reason why  they                                                               
downgraded  their  work  requirements. The  tracking  system  and                                                               
paperwork needed  to demonstrate  20 hours  of paid  or volunteer                                                               
work made the cost almost  a wash. Philosophically there are many                                                               
reasons  to support  the bill,  but  the question  is whether  an                                                               
already over-taxed department can take this on.                                                                                 
                                                                                                                                
SENATOR  MICCICHE asked  if the  committee's only  responsibility                                                               
was  a workload  and money-saving  question or  if part  of their                                                               
responsibility was  to put policies  in place to break  the cycle                                                               
and help Alaskans  succeed in this generation and  in the future.                                                               
He said he  cannot isolate his consideration to  today's cost and                                                               
administrative burden. He  has to look at the people  who are not                                                               
reaching their ultimate potential and  the systems that have been                                                               
set up to actually compromise success and potential.                                                                            
                                                                                                                                
CHAIR WILSON  asked if the  department could put together  a memo                                                               
to summarize all the costs and savings and how they interact.                                                                   
                                                                                                                                
1:54:11 PM                                                                                                                    
JON  SHERWOOD,  Deputy  Commissioner, Department  of  Health  and                                                               
Social Services  (DHSS), said they'd  be happy to put  together a                                                               
table to  summarize all the  fiscal notes, both theirs  and other                                                               
departments, to explain the different pieces.                                                                                   
                                                                                                                                
CHAIR WILSON said that would be helpful for the general public.                                                                 
                                                                                                                                
SENATOR BEGICH  asked how  many people  DHSS determined  might be                                                               
affected by SB 193 and how they arrived at that number.                                                                         
                                                                                                                                
1:55:24 PM                                                                                                                    
MONICA   WINDOM,  Director,   Division   of  Public   Assistance,                                                               
Department  of  Health  and Social  Services  (DHSS),  said  they                                                               
looked at the entire Medicaid  caseload and removed children, the                                                               
elderly,  the   disabled,  and  people  receiving   ATAP  [Alaska                                                               
Temporary Assistance Program] because  it has a work requirement.                                                               
That left about 25,000 people.                                                                                                  
                                                                                                                                
SENATOR BEGICH  asked if  the exemptions  on page  2 of  the bill                                                               
were included.                                                                                                                  
                                                                                                                                
MS. WINDOM said yes.                                                                                                            
                                                                                                                                
SENATOR MICCICHE  noted that individuals  on any DHSS  program go                                                               
through an eligibility analysis so  the extra effort would likely                                                               
amount to simply adding another column.                                                                                         
                                                                                                                                
MS. WINDOM  said the guidance  from CMS  is to follow  ATAP rules                                                               
and  those case  managers spend  about 9.5  hours and  $5,500 per                                                               
person  per year.  The  fiscal  note for  SB  193 reflects  their                                                               
assumption that  most of  these people do  not have  children and                                                               
will be  easier to  serve than  someone on  temporary assistance.                                                               
They estimated case  managers would spend between  three and five                                                               
hours a year per person.                                                                                                        
                                                                                                                                
SENATOR  MICCICHE   said  it  won't   require  an   entirely  new                                                               
bureaucracy to account  for work requirements. It  is applying it                                                               
to more people and more recipients of other programs.                                                                           
                                                                                                                                
MS. WINDOM  said the basic concepts  are the same, but  DHSS does                                                               
not have the  staff to work with this large  group of people. The                                                               
ATAP caseload  is 3,000 and  the work  services line for  that is                                                               
$11 million. The estimate for this is for 25,000 people.                                                                        
                                                                                                                                
SENATOR MICCICHE said  when he recently asked how  many people of                                                               
the  Medicaid  population  were  working, he  got  a  very  quick                                                               
answer. He  said he assumes  the answer came quickly  because the                                                               
department understands  the proportion of people  who are already                                                               
working.                                                                                                                        
                                                                                                                                
1:58:45 PM                                                                                                                    
MR.   SHERWOOD  explained   that  an   eligibility  determination                                                               
includes whether  someone is  working and  has an  earned income.                                                               
The people  that are covered by  the fiscal notes do  not have an                                                               
earned income.  They assumed that  initially about  25,000 people                                                               
would be  on Medicaid and not  covered by one of  the exemptions.                                                               
Over  time  some  people  will   drop  out  of  the  program  for                                                               
noncompliance so  the number  will drop.  Over three  years, that                                                               
number  will  probably  stabilize   at  18,000.  He  agreed  with                                                               
Director Windom's point  that it would take a lot  more people to                                                               
do the  work services  for 18,000  than for  the 3,000  people on                                                               
ATAP.  The CMS  letter  is  clear that  providing  some level  of                                                               
supported  services  is  expected  if the  loss  of  Medicaid  is                                                               
imposed as a result of noncompliance.                                                                                           
                                                                                                                                
CHAIR WILSON asked  whether the state could  add this requirement                                                               
to the work services it already contracts out.                                                                                  
                                                                                                                                
MR. SHERWOOD  confirmed that  DHSS does  a substantial  amount of                                                               
contracting.  They do  some in-house  work with  ATAP with  their                                                               
employment services.  Something unusual about the  State Medicaid                                                               
Director Letter  is that it states  that work supports are  not a                                                               
Medicaid   eligible  expense.   While  states   must  make   them                                                               
available, there are  no federal funds for that.  DHSS thinks the                                                               
argument can  be made that if  they keep the work  in-house, they                                                               
can   claim  it   is  part   of  the   eligibility  and   program                                                               
administration and  they will  claim the  federal share  for that                                                               
staff. If  DHSS puts it  out for a  contract, they would  have to                                                               
treat it  all as work services  and not claim any  federal match.                                                               
They would negotiate  with the federal government  about where to                                                               
claim  the federal  match as  appropriate.  Their expectation  is                                                               
that work  services itself is  not eligible for a  federal match.                                                               
Over time, the total savings  are substantial but mostly in areas                                                               
of federal funds and the expenditures are in general funds.                                                                     
                                                                                                                                
2:02:55 PM                                                                                                                    
SENATOR VON  IMHOF said it  is important to fully  understand the                                                               
impact  of this.  She  read  an article  that  other states  have                                                               
discovered that when people are asked  to go to work, the federal                                                               
government  does not  cover job  training, childcare  assistance,                                                               
transportation,  and other  services.  The estimate  is that  the                                                               
state will  pay $1,000  per enrollee, which  is $21  million each                                                               
year. The  fiscal note estimates  49 new DHSS employees  to track                                                               
this, plus  the price  of computers  and cubicles.  She expressed                                                               
interest in leverage existing programs  like TANF versus creating                                                               
a new department.                                                                                                               
                                                                                                                                
CHAIR WILSON said the 2015  DHSS audit pointed out inefficiencies                                                               
in  the  Division  of  Public   Assistance  that  have  been  not                                                               
addressed to  date. Working  on two systems  instead of  one, for                                                               
example. He  asked if the fiscal  note reflects some of  the same                                                               
issues highlighted in the 2015 audit.                                                                                           
                                                                                                                                
MS. WINDOM  said the majority  of staff  request is for  the work                                                               
services piece,  not the  eligibility piece. They  did ask  for a                                                               
few  more  eligibility  technicians to  implement  penalties  for                                                               
noncompliance. DHSS  is working to  improve its system  and hopes                                                               
to be in  one system within 3  years. Part of the  fiscal note is                                                               
to  reprogram the  system  to  put the  work  requirement in  and                                                               
provide a penalty for noncompliance.                                                                                            
                                                                                                                                
2:06:50 PM                                                                                                                    
SENATOR MICCICHE said the CMS  guide talks about their commitment                                                               
to  support  state  demonstrations that  require  eligible  adult                                                               
beneficiaries  to  work or  engage  in  community activities.  He                                                               
asked  if they  have  published any  other  document to  describe                                                               
their commitment and what that support may look like.                                                                           
                                                                                                                                
MR.  SHERWOOD  said  he  is  not aware  of  any  other  published                                                               
guidance from CMS.                                                                                                              
                                                                                                                                
SENATOR  MICCICHE said  he would  welcome any  evidence of  CMS's                                                               
ability to support training programs.                                                                                           
                                                                                                                                
2:08:34 PM                                                                                                                    
CHAIR WILSON opened public testimony.                                                                                           
                                                                                                                                
2:08:56 PM                                                                                                                    
MIKE  COONS,   President,  Alaska  Chapter  of   Mature  American                                                               
Citizens  (AMAC), supported  SB 193.  He  said AMAC,  which is  a                                                               
conservative organization  for senior citizens in  Alaska, has an                                                               
Alaskan membership  of 4,500. Those  able-bodied people  added to                                                               
Medicaid in the Obama era and  by the governor against the wishes                                                               
of the majority  in the House and Senate, as  well as against the                                                               
wishes of a  large part of the population of  Alaska, are part of                                                               
the failed  great society of  the LBJ  administration. Nationally                                                               
the country  has lost more  than $2  trillion since then  and has                                                               
generations  of families  that do  not work  yet eat  better than                                                               
most working  Alaskans. He opined that  Medicaid puts able-bodied                                                               
people over those working or  retired citizens who have Medicare.                                                               
He  has heard  that adding  able-bodied to  Medicaid hurts  those                                                               
whom  Medicaid  was intended  for,  those  with true  needs.  The                                                               
American  with Disabilities  Act  was passed  to enable  disabled                                                               
people to work,  but Medicaid removes the incentive  to work. The                                                               
value  of  work  for  self-esteem  for  anyone  with  a  physical                                                               
challenge is more  helpful both physically and  mentally than not                                                               
working and living on government  handouts. He said those who can                                                               
work  to work  should be  encouraged to  do so.  He said  DHSS is                                                               
trying to  help people by  spending more  money, which he  is not                                                               
too happy  about, but the minimum  wage of $9.86 per  hour for 20                                                               
hours  for 25,000  people  is $236,160,000  a  year of  increased                                                               
income into people's wallets and into the economy.                                                                              
                                                                                                                                
2:12:37 PM                                                                                                                    
SENATOR BEGICH asked if he supports the exemptions.                                                                             
                                                                                                                                
MR. COONS said they are reasonable.                                                                                             
                                                                                                                                
2:13:52 PM                                                                                                                    
JESSICA CLER,  Alaska Public Affairs Manager,  Planned Parenthood                                                               
Votes  Northwest and  Hawaii, opposed  SB 193.  She said  Planned                                                               
Parenthood  is  the  nation's  leading  provider  of  sexual  and                                                               
reproductive health. In  2015, 26 percent of  their patients were                                                               
Medicaid  beneficiaries.  Planned   Parenthood  is  committed  to                                                               
everyone  in the  state having  access  to the  health care  they                                                               
need, regardless of  their income or where  they live. Enrollment                                                               
restrictions like those  proposed in SB 193  will decrease access                                                               
to  health care  in Alaska  and disproportionately  impact women.                                                               
Medicaid covers one of five women  of reproductive age and is the                                                               
source of  coverage for nearly  half of women giving  birth. Many                                                               
women  face barriers  to work  such  as transportation,  housing,                                                               
education,  and   abusive  relationships.  Research   shows  work                                                               
requirements do  not decrease  poverty and,  in some  cases, push                                                               
families deeper into poverty.                                                                                                   
                                                                                                                                
She said SB 193 would cut  Alaskans off from the care they depend                                                               
on without  improving their  economic stability.  Burdensome work                                                               
requirements  are not  the best  way  to improve  the health  and                                                               
well-being of Alaskan women and  families. To support the dignity                                                               
and economic well-being of Alaskans,  the state must preserve and                                                               
expand access to Medicaid. Medicaid  coverage makes it easier for                                                               
women to  secure and maintain  employment, it  provides treatment                                                               
for conditions that may keep  them from working, and its coverage                                                               
of family planning  allows women to pursue  their educational and                                                               
career  goals.  She  urged  the  committee  to  focus  on  proven                                                               
policies to improve women's health and economic security.                                                                       
                                                                                                                                
2:16:14 PM                                                                                                                    
JEREMY PRICE,  Alaska State  Director, Americans  for Prosperity,                                                               
supported SB  193. He said  this is  a fabulous step  forward for                                                               
Alaskans.  The United  Kingdom Department  for Work  and Pensions                                                               
commissioned a  study ten years  ago entitled, "Is Work  Good for                                                               
Your  Health  and Well-being?"  Doctors  Gordon  Waddell and  Kim                                                               
Burton concluded, "There  is a strong evidence  base showing that                                                               
work is generally  good for physical and mental  health and well-                                                               
being.  Worklessness  is  associated  with  poorer  physical  and                                                               
mental health.  Work can be  therapeutic and reverse  the adverse                                                               
health effect  of unemployment. That  is true for  healthy people                                                               
of working  age, many  disabled people,  most people  with common                                                               
health  problems,   and  social  security   beneficiaries."  This                                                               
legislation only impacts Medicaid  recipients who are working age                                                               
and  able-bodied who  can work  but  choose not  to. In  February                                                               
Americans for Prosperity made the following statement:                                                                          
                                                                                                                                
     Beginning   with  former   Mayor   Rudy  Giuliani   and                                                                    
     continuing with Mayor Michael  Bloomberg, New York City                                                                    
     became a  model for  how work requirements  for welfare                                                                    
     applicants and  recipients could contribute to  a steep                                                                    
     drop in a  city's welfare caseload. From  1995 to 2013,                                                                    
     the  number  of welfare  recipients  in  New York  City                                                                    
     shrank from almost  1.1 million to less  than 347,000                                                                      
     a drop of more than 700,000 men, women and children.                                                                       
                                                                                                                                
     But while New York City may have undergone the most                                                                        
     visible transformation, other states and localities                                                                        
     across the country were seeing similar success.                                                                            
                                                                                                                                
     Among the most promising examples of work requirements                                                                     
     empowering able-bodied adults were the results of 2013                                                                     
     Kansas reforms to the food stamp program. Prior to                                                                         
     instituting new food stamp work requirements, Kansas                                                                       
     was spending nearly $5.5 million per month on                                                                              
     government assistance programs, while 93 percent of                                                                        
     food stamp recipients were living in poverty. Few of                                                                       
     the recipients claimed any income, with only 21                                                                            
     percent working at all, and 40 percent working fewer                                                                       
     than 20 hours per week.                                                                                                    
                                                                                                                                
     Soon after work requirements were implemented,                                                                             
     thousands of food stamp recipients in Kansas moved                                                                         
     into the workforce, resulting in a decrease in                                                                             
     poverty, with 40 percent of former food stamp                                                                              
     recipients finding a job within the first three                                                                            
     months, and nearly 60 percent within a year. The                                                                           
     people who moved off of food stamps and found a job                                                                        
     weren't "punished," they lifted themselves out of                                                                          
     poverty and improved their lives.                                                                                          
                                                                                                                                
MR.  PRICE  said  this  bill  is about  improving  the  lives  of                                                               
Alaskans  by  providing incentives  for  them  to be  more  self-                                                               
sustaining  and provide  benefits for  themselves instead  of the                                                               
government.  This  reform  helps people,  helps  Alaskans  better                                                               
themselves,  their  situation,  and their  health  outcomes  will                                                               
improve.  Since his  testimony is  long, he  will submit  written                                                               
testimony.                                                                                                                      
                                                                                                                                
SENATOR MICCICHE asked  Mr. Price to forward his  data sources to                                                               
the chair for distribution to the committee.                                                                                    
                                                                                                                                
2:20:02 PM                                                                                                                    
CHAIR WILSON closed public testimony.                                                                                           
                                                                                                                                
2:20:14 PM                                                                                                                    
SENATOR  GIESSEL  referenced  a longitudinal  study  of  Alaska's                                                               
remote  Arctic  communities and  the  life  expectancy since  the                                                               
development  of  oil  resources  on the  North  Slope.  The  life                                                               
expectancy of people living in  the rural Arctic now exceeds that                                                               
of major cities  in the lower 48, attributable to  the ability to                                                               
have an  income and work.  She offered to  provide a copy  of the                                                               
study to the committee.                                                                                                         
                                                                                                                                
CHAIR WILSON held SB 193 in committee.                                                                                          
                                                                                                                                
2:21:10 PM                                                                                                                    
There being no further business to come before the committee,                                                                   
Chair Wilson adjourned the Senate Health and Social Services                                                                    
Committee at 2:21.                                                                                                              
                                                                                                                                

Document Name Date/Time Subjects
SB 193 Version D Sponsor Statement.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Version D Sectional.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Version D CMS Letter 1.11.18.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Version D.pdf SHSS 3/12/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS DPA Field Svcs.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note Dept Admin - Cent Admin Svcs.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS DPA QC.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS DPA Work Svcs.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS Med Svcs Adult Dental.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS Medicaid Services.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DHSS Medicaid Svcs BH.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Fiscal Note DLWD E&TS.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
Support Letter for SB 193.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Support M Coons.pdf SHSS 3/12/2018 1:30:00 PM
SHSS 3/26/2018 1:30:00 PM
SB 193
SB 193 Medicaid Work Requirement Testimony - Americans for Prosperity.docx SHSS 3/12/2018 1:30:00 PM
SB 193